Disclosures: Jing Lin, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 35-year-old male presents with longitudinal extensive transverse myelitis (LETM) due to Primary Central Nervous System Lymphoma (PCNSL).

Case Description: A previously healthy 35-year-old male presented with acute onset lower extremity weakness and urinary retention. Magnetic resonance imaging (MRI) revealed LETM and multiple enhancing cerebral lesions. Cerebrospinal fluid studies showed slightly elevated immunoglobulin-G, without oligoclonal bands. Autoimmune and infectious serologies were negative. After treatment with a five-day steroid course, the patient’s symptoms resolved. However, symptoms recurred ten days later with new persistent low grade fevers. There was no improvement despite repeat treatment with steroids or intravenous immunoglobulin. Infectious and venous thrombosis workup were negative. Patient was then transferred to acute inpatient rehabilitation, where he developed high grade fevers and somnolence. MRI brain revealed significantly increased cerebral and brainstem lesions with vasogenic edema and mass effect. Despite antibiotics, steroids, and plasmapheresis, encephalopathy progressed and the patient was intubated for airway protection. Given critical illness, brain biopsy was done and revealed diffuse large B-cell lymphoma.

Setting: Academic hospitalAssessment/

Results: Patient was treated with methotrexate, with improvement in cerebral lesions, edema and mass effect. However, he remains critically ill from septic shock, respiratory failure and renal insufficiency.

Discussion: PCNSL is a rare tumor that affects the brain, eyes and spinal cord. When suspected, patients should be evaluated with MRI, lumbar puncture and eye slit lamp. Brain stereotactic needle biopsy is the diagnostic procedure of choice. Treatment includes high dose methotrexate. This report presents an unusual cause of transverse myelopathy, and demonstrates the importance of considering PCNSL in the differential for LETM

Conclusion: PCNSL is seldom considered in the differentials for LETM. Patients with unrevealing etiologic workup and lack of functional improvement despite comprehensive treatment should be worked up for PCNSL.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/primary-central-nervous-system-lymphoma-as-an-unusual-cause-of-transverse-myelitis-a-case-report/